Urinary incontinence and voiding dysfunctionare common, chronic, and costly health problems in women with type 2 diabetes. Nearly 60% of women with diabetes report weekly incontinence and consider their ncontinence bothersome, and about 20% report that it interferes with their daily lives- two times more Sequent than incontinent women without diabetes. However, our understanding of the natural history,risk 'actors of new onset and worsening symptoms, possible mechanisms, and interventions to prevent orreduce severity of incontinence among women with type 2 diabetes is limited. The proposed prospective study will build upon the well-characterized Diabetes Reproductive Risks of incontinence Study (RRISK). The Diabetes RRISK is a population-based ethnically diverse cohort of400 women with type 2 diabetes that includes extensive assessment of lower urinary tract function by in-person interview, self-report, chart abstraction, voiding diaries, post-void residual volumes, and in a sample, objective measures of bladder function including uroflow and urodynamics. In addition, the DiabetesRRISK includes a broad range of diabetes measures such as duration, treatment, glycemic control, complications of diabetes, and laboratory data. With links to all laboratory, radiology, inpatient, outpatient, pharmacy, and surgery Kaiser clinical databases, the study provides an unequalled level of detail. The proposed longitudinal Diabetes RRISK will follow the women for 5 years to determine risk factors for and new onset andincreases in the severity of incontinence. The overarching goal of the proposed study is to advance our understanding of the natural historyand pathophysiology of incontinence in diabetic women. The linkage of our clinical study and the SCOR Basic Mechanisms Project using a unique type 2 diabetes rat model will help us to understand the broader context of incontinence and diabetic voiding dysfunction as well as characterize underlyingmolecular mechanisms. Ultimately, a deeper understanding of the epidemiology and pathophysiology of incontinence anddiabetic voiding dysfunction in women with diabetes may be helpful in the developmentof new prevention andearly treatment strategies for these conditions.